Lizette Lopez 12.31.23MIAMI E
BO ARD AND COM M ITTEE CHECKLIST
APPOINTEE: Liz .ette Lopez
BOARD/COMMITTEE: Police/Citizen Relations
DATE OF APPOINTMENT. 2/9/23 -------
Appointed by: Commissioner Fernandez
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment
2/9/23
TERM END. 12/31/23 TERM LIMrr. 12/31/30
e-mailed to Committee Liaison on
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o Board and Committee Application (Completed on _
o R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed , 2/16/23
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
REC EI VED city code sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
✓County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
FEB 1 6 2023 ✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
CITY O F M IAM I BEAC H ✓Sunshine Law and Public Records - Frequently Asked Questions
OFFICE OF THE CITY CLERK ✓Memorandum - Solicitation by City Board and Committee Members
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o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
o DIVERSITY STATISTICS REPORTING
2l[(o/23 soea»y } re at
Date / Boa a or Committee M
Processed on: __ '2-_/_l_{p __ Z-_~ __ By Employee: __,K~_ AJ)-+------------
2- {, &'e/ 2'-
3
City Clerk~Staff Initials
__________ By Employee: _
Received on:
Scanned on:
Date City Clerk's Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:\C LER\BO AR D AN D CO M M ITT IES DATABASE\CHECKLI ST MASTER\B&C Checklist 2015 MASTER.docx
W e are committed to providing excellent pub~ic service and safety to all who live, work, and play in our vibrant, tropical, historic community.
M IA M I BE
City of Miami Beach, I/OO Convention Cantor Drive, Miami Bach, Florida 33 139 yxy_miamibaachllgov
OFFICE OF THE CITY CLERK, Raf0al E. Gran ado, City Clerk
Tel: 3 05.6 73.74 11, Fax: 305.673.7254
Email: Cit/Cl erk @miamibooch ll.gov
February 09, 2023
Ms. Lizette Lopez
5042 Alton Road
Miami Beach, Florida 33140
RE: Police/Citizens Relations Committee
Dear Ms. Lizette Lopez:
Congratulations! You have been appointed by Commissioner Alex Fernandez to the above-referenced
Board or Committee, for a term ending: 12/31/2023.
Pursuant to City of Miami Beach Code Section 2-22 (5)a:
Notwithstanding any other provision of the City Code or of any Resolution, commencing with
terms beginning on or after January 1, 2007, the term of every board member who is directly
appointed by a member of the City Commission shall automatically expire upon the latter of:
December 31 of the year the appointing City Commissioner leaves office or upon the
appointment/election of the successor City Commission member.
If you are unable to accept this appointment, or have any questions, please call the Office of the City
Clerk at 305.673. 7411.
Please read the enclosed materials carefully as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
;/ .a9..
City Clerk
cc: Monica Beltran, Parking Director
Chief Rick Clements, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 - Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MI MI B
City of M iam i Beach, 1/0O Convention Coner Drive, Miami Beach, Fonda 33 139 yyywy_miaribagch[l_gay
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Ci#yClerk@miamibeach ll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Lizette Lopez
RE: Police/Citizens Relations Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United
States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a member of the
above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a
term ending: 12/31/2023.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
actions taken and all communications made by me as a public servant.
I have been issued a copy of section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and
Code of Ethics Ordinance), as well as Florida Commission on Ethics Guide to the Sunshine Amendment
and Code of Ethics for Public Officers and understand that as a member of a City of Miami Beach Board
and/or Committee, I must comply with the financial disclosure* requirements of Miami-Dade County or the
State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
Ms. Lizette
sworn to an d subscribe d before me # ly h day of,i; 2023
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
MI A MI B
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachf_gov
Telephone: 305 .673 7411
RECEIVED
FEB 16 2023
CITY O F M IAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
( ✓) all that apply):
lam a resident of the City of Miami Beach for six months or longer.
tore A«ares 309/ 7on
□I have an ownership interest (for a minimum of six months) in a business established in the City of
Miami Beach (for a minimum of six months).
Name of Business ------------------------
[I[[es,S J\(]]feSS
□I am a full-time employee of a business (for a minimum of six months) and I am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months).
[]are f Hy1[@SS
[/Jg[no,, J\(]]f@,S
"Ownership Interest" means the ownership of ten percent (10%) or more (including the ownership of
10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
Under penaltjes of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. h 6, olo /33
Signature
Liz ette Lopez
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization,
to_ aaaRC b 6 2023 . Ly2Hl Loo-€2
(([[/ of Miami Beach Board/Committee Member).
# hue' L en£e Produced ID
fication
Name of Notary, Typed, Printed, or Stamped
M IA M IB E
City of Miami Beach
1700 Convention Center Drive
M ia m i Be a ch , Flo rid a 33139
www._m iam i b e a ch []_g o v
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT o c 2
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
LJ at e
Ll remale
D Other
DI I prefer not to answer.
Race/Ethnic Categories:
What is your race?
[] African American/Black
Ll Asta or Pacific Islander
0 Caucasian/White
LI Native American/American Indi an ,
[I other - Print Race: ~rd-
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
f a.
(Jo
D I prefer not to answer.
Do you consider yourself Physically Disabled?
Ives r
'I No
L l\prefer not to answer this question.
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F:IC LER \$ALL\REG \BO ARD AND CO M M ITT EE APPLI C ATIO NS FINAL DRAFTS\BO ARD AND CO M MITT EE APPLI CATIO N REG FINAL.docx
Updated: June 2020
N \IA M IB E H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC @ m ia m ib e a chfl.g o v
Telephone: 305.673.7 411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
#
Last Nano First Name Middle Initial
I understand that no later than July 1, of each year all members of Boards and Committees of the City of Miami
Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial
Disclosure Requirements.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year:
1. A "Source of Income Statement;" or
2. A "Statement of Financial Interests (Form 1 )1 ;" or
3. A Copy of your latest Federal Income Tax Return.
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $50~ays in jail, or both. ,/4
• •Ueda
1 Memb ers of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. $112.3145(1)a) to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
require ment.
Page 5 of 6
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Updated: June 2020
M IA M l·DA D E-
EMI SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code require s that certain em ployees and public offi cials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending ; First N<ll11 ffi Middle Nam e/Initial
2022 0pe2 ze '<
"$777"% %/al pee m 337 /0
City, State, Zip
If your hom e address is your m ailing address, and your hom e addre ss is exem pt fro m public re cords pursuant to Fla. Stat. $119.07, read
instructions on the follow ing page and check here. D
Filing as an Employee (ch eck one)
[] county [] Public Health Trust [] Municipal:
(M unicipality)
Departm ent
Positi on or Titl e Em ployee ID Num ber
W ork address I W ork telephone Em ployment began on/ended on
Filing as a Board Member (check one)
[] county [iunicipal: // eek
(M unicipality)
Board ~efving / I Ks fie hes
Altern ate address (if hom e address is exem pt) I W ork telephone I Term began on/ended on
List below every source of incom e you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, with the largest source first. Exam ples of sources of incom e include: com pensation for services, incom e fro m business, gains fro m
pro pert y dealings, intere st, rents, dividends, pensions, IRA distributions, and social security paym ents. Also, include any source of incom e received by another
person for your benefit. How ever, the incom e of your spouse or any business partner need not be disclosed. If continued on a separa te sheet, ch eck her e.[]
Nam e of Source of Incom e Address Description of the Principal Business Activity
0/0
I here by sw ear (or affi rm ) that the inform ation above is a true and corre ct statem ent. + 2 Signature of Person Disclosing~
Date signed
RECEIVED BY ELECTIO NS DEPARTMENT:
D Hardcopy RECEIVED
[] Electronic Copy
FEB 16 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFIC E USE O N LY Accepted: Y / N Deficiency. Processed Date/Initials: Scanned Date/initials:
138_SP-14 COE 2016
M IAM I B CITYW IDE (CW ) BOA RD & COM M ITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessary enforcement actions, it is important that our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/ or outdated vehicle
information may lead to the issuance of parking citation(s) and/or the towing of your vehicle.
Please note that this new access card CANNOT be hole-punched or perforated in any manner. To use
the new card please hold the card at close proximity to the reader until the gate opens. You may need
to try the other side of the card. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: 7-1 7
Applicant Name: Lizzette Lopez
Board/Committee Name: Police/Citizen Relations
Address: 504.2 77o) 20 Mt/r0co e oh f/ 3/40
EMail Address p4, c @e/lo Y. e} e"e 1
Work Phone: V Home Phone 81- 7o5 - 30
c ell Phone3 76-575 Preferred Contact Method:
Vehicle Information
Tag: cissy9t y1 28> Color:
State: FL Year:
Make: ZeN o 2 Model:
Applicant Sianature: ef k $e.
Please provide signed form to lhe Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
P, ·ti D ar Ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature: e
Date Issued: Date Completed:
s
:.p mg man rar torm s cw oatds commtees parugtorm.doc orm upaote